Partnership Application Supplement Form
Supplement Form Submission Information
Mail:
In-person:
Partnership Application Supplement Forms can be mailed
Students can complete and drop off the
to Cleveland State University’s Registrar’s office for
Partnership Application Supplement form to the
processing. Please mail to the following address:
CSU Partnership office and the Cleveland State
Cleveland State University Admissions Processing UN 300
Staff will forward the Supplement form to the
2121 Euclid Ave.
Cleveland State University Registrar’s Office.
Cleveland, Ohio 44115
*Supplement form MUST be submitted during the application process.
Select your community college


Lakeland Community College
Lorain County Community College
Select a Partnership Program
Lakeland Community College
 General Business
 Psychology
 Public Safety Management
 Organizational Leadership
 Urban Studies
Lorain County Community College
 Nonprofit Administration
 Psychology
 Public Safety Management
 Spanish
 Urban Studies
 Organizational Leadership
Student Information
Name: ________________________________________________________________
Address: _______________________________________________________________
______________________________________________________________________
Phone: __________________________
Email: ______________________________________
Community College ID #: _______________________
CSU ID # (If applicable): ________________________
Intended semester & year of admission: _____________________________
I certify that the information provided on this supplement form is accurate, complete and subject to verification. I understand that all required
application information will be evaluated for admission. I also understand that any misrepresentation or omission may be cause for the University to
deny or cancel admission and registration, revoke financial aid, refuse posting of transfer credit and suspension from the University if discovered
subsequently.
I understand that it is my individual responsibility to request my official transcripts from high school and all colleges and universities attended in
order to complete the application process. Upon admission to Cleveland State University I authorize each high school, college or university I
have attended to release and share my academic information and records as deemed necessary by each institution for the purpose of program
review and evaluation until my program completion at Cleveland State University.
I hereby declare my intention to participate in the Cleveland State University/ LCC/ LCCC Partnership Program.
Signature: _______________________________________
Rev. May. 9, 2016 KMC
Date: _______________
Submission of this supplement form waives the Cleveland State University application fee for partnership students.
Students applying online should choose the “pay by mail” option on the application. DO NOT submit payment – fee
is waived when supplement form is received. If a payment is made, CSU is not able to refund the fee.